Cyclic polypeptides for pcsk9 inhibition

ABSTRACT

Provided herein are cyclic polypeptide compounds that can, e.g., bind specifically to human proprotein convertase subtilisin/kexin type 9 (PCSK9) and optionally also inhibit interaction between human PCSK9 and human low density lipoprotein receptor (LDLR), and pharmaceutical compositions comprising one or more of these compounds. Also provided are methods of reducing LDL cholesterol level in a subject in need thereof that include administering to the subject one or more of the cyclic polypeptide compounds or a pharmaceutical composition provided herein.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Ser. No. 62/688,050, filed Jun.21, 2018, which is incorporated herein by reference in its entirety.

BACKGROUND

Hypercholesterolemia is characterized by the presence of high levels oflow-density lipoprotein (LDL) cholesterol in the blood, which can leadto the development of atherosclerosis and associated ischemiccardiovascular disease (e.g., myocardial infarction and stroke) (Lambertet al., J. Lipid Res. 53:2515-2524, 2012). More than 34 million Americanadults have hypercholesterolemia (NIH Genetics Home Reference Website,2014). Proprotein convertase subtilisin/kexin type 9 (PCSK9) has beenproposed as a target for treatment of hypercholesterolemia.

PCSK9 is a proprotein convertase belonging to the proteinase K subfamilyof the secretory subtilase family. PCSK9 binds to the epidermal growthfactor-like-repeat A (EGF-A) domain of the low-density lipoproteinreceptor (LDLR) and directs LDLR to lysosomes, where it is degraded.Inhibition of PCSK9 leads to increased LDLRs at the cell surface,resulting in increased removal of LDL from the extracellular fluid.Therefore, the inhibition of PCSK9 results in lower LDL cholesterolconcentrations in the blood.

There remains a need in the art for compounds that inhibit the bindingof PCSK9 to LDLR, and treat or prevent hypercholesterolemia.Administration of these compounds can lead to significantly improvedprognosis, diminished progression of hypercholesterolemia, and adecrease in diseases related to hypercholesterolemia.

SUMMARY

Provided herein are cyclic polypeptides useful for the inhibition ofPCSK9 in a subject in need thereof. In particular, provided herein arecyclic polypeptide compounds having the structure of Formula (I):

or a pharmaceutically acceptable salt thereof.

Also provided herein are cyclic polypeptide compounds having thestructure of Formula (II):

or a pharmaceutically acceptable salt thereof.

Also provided herein are bicyclic polypeptide compounds having thestructure of Formula (III):

or a pharmaceutically acceptable salt thereof;

provided either R₃ and R₇, or R₆ and R₁₀ are covalently bound by alinking moiety selected from the group consisting of

Also provided herein is a cyclic polypeptide compound selected fromcompounds 001, 002, 003, 004, 005, 006, 007, 008, 09, 010, 011, 012,013, 014, 015, 016, 017, 018, 019, 020, 021, 022, 023, 024, 025, 026,027, 028, 029, 030, 031, 032, 033, 034, 035, 036, 037, 038, 039, 040,041, 042, 043, 044, 045, 046, 047, 048, 049, 50, 51, 52, and 53.

Also provided herein is a bicyclic polypeptide compound selected fromcompounds 045, 049, 102, 103, 104, 105, 116, and 117.

In an embodiment, provided herein is a pharmaceutical compositioncomprising one of the compounds of Formula (I), Formula (II), Formula(III), or compounds 001-105, together with a pharmaceutically acceptablecarrier.

Also provided herein is a method of reducing low density lipoprotein(LDL) cholesterol level in a subject in need thereof comprisingadministering to the subject a therapeutically effective amount of oneor more of cyclic polypeptide compounds of Formula (I), Formula (II),Formula (III), or compounds 001-105, or a pharmaceutical compositioncomprising one or more of cyclic polypeptide compounds of Formula (I),Formula (II), Formula (III), or compounds 001-105.

In addition, provided herein is a method of treatinghypercholesterolemia in a subject in need thereof comprisingadministering to the subject a therapeutically effective amount of oneor more cyclic polypeptide compounds of Formula (I), Formula (II),Formula (III), or compounds 001-105, or a pharmaceutical compositioncomprising one or more of cyclic polypeptide compounds of Formula (I),Formula (II), Formula (III), or compounds 001-105. Additionally,provided herein is a method of treating a disease that shows comorbiditywith hypercholesterolemia in a subject in need thereof comprisingadministering to the subject a therapeutically effective amount of oneor more cyclic polypeptide compounds of Formula (I), Formula (II),Formula (III), or compounds 001-105, or a pharmaceutical compositioncomprising one or more of cyclic polypeptide compounds of Formula (I),Formula (II), Formula (III), or compounds 001-105. For example, thedisease that shows comorbidity can be one or more of nephrotic syndrome,kidney failure, coronary artery disease, atherosclerosis, stroke,peripheral vascular disease, diabetes, and high blood pressure.

Also provided herein is a method of inhibiting PCSK9 activity comprisingadministering to a subject in need thereof a therapeutically effectiveamount of one or more cyclic polypeptide compounds of Formula (I),Formula (II), Formula (III), or compounds 001-105, or a pharmaceuticalcomposition comprising one or more of cyclic polypeptide compounds ofFormula (I), Formula (II), Formula (III), or compounds 001-105.

In addition, provided herein is a method of inhibiting the interactionbetween PCSK9 and the EGF-A domain of LDLR in a subject in need thereofcomprising administering a therapeutically effective amount of one ormore cyclic polypeptide compounds of Formula (I), Formula (II), Formula(III), or compounds 001-105, or a pharmaceutical composition comprisingone or more of cyclic polypeptide compounds of Formula (I), Formula(II), Formula (III), or compounds 001-105.

Also provided herein is a method of inhibiting PCSK9 activity in a cellcomprising contacting the cell with one or more cyclic polypeptidecompounds of Formula (I), Formula (II), Formula (III), or compounds001-105, or a pharmaceutical composition comprising one or more ofcyclic polypeptide compounds of Formula (I), Formula (II), Formula(III), or compounds 001-105.

DETAILED DESCRIPTION OF THE DISCLOSURE

Provided herein are cyclic polypeptide compounds, and pharmaceuticalcompositions comprising such compounds, that are useful for theinhibition of PCSK9. For example, the compounds are useful in inhibitingthe interaction between human PCSK9 and the EGF-A domain of human LDLRin subject. These compounds and pharmaceutical compositions are alsouseful for the treatment of hypercholesterolemia, as well as diseasesthat show comorbidity with hypercholesterolemia.

Definitions

Listed below are definitions of various terms used to describe thisinvention. These definitions apply to the terms as they are usedthroughout this specification and claims, unless otherwise limited inspecific instances, either individually or as part of a larger group.

Unless defined otherwise, all technical and scientific terms used hereingenerally have the same meaning as commonly understood by one ofordinary skill in the art to which this invention belongs. Generally,the nomenclature used herein and the laboratory procedures in cellculture, molecular genetics, organic chemistry, and peptide chemistryare those well-known and commonly employed in the art.

As used herein, the articles “a” and “an” refer to one or to more thanone (i.e., to at least one) of the grammatical object of the article. Byway of example, “an element” means one element or more than one element.Furthermore, use of the term “including” as well as other forms, such as“include,” “includes,” and “included,” is not limiting.

As used herein, the term “cyclic polypeptide compounds” meanspolypeptide chains in which the amino termini and carboxyl termini;amino termini and side chain; carboxyl termini and side chain; or sidechain and side chain, are linked with a covalent bond that generates thering.

As used herein, the term “disease that has comorbidity withhypercholesterolemia” means a disease in which elevated cholesterollevels (e.g., elevated LDL cholesterol levels) (e.g., as compared to areference level) are associated with an elevated risk of developing thedisease and/or an elevated risk of poor prognosis of the disease (e.g.,increased risk of severe disease, increased risk of death, and/or anincreased risk of cardiovascular event (such as stroke, myocardialinfarction, or heart disease)) (e.g., as compared to a subject nothaving an elevated LDL cholesterol level, e.g., as compared to areference level).

As used herein, the term “treatment” or “treating” is defined as theapplication or administration of a therapeutic agent, i.e., a compoundof the invention (alone or in combination with another pharmaceuticalagent), to a patient, or application or administration of a therapeuticagent to an isolated tissue or cell line from a patient (e.g., fordiagnosis or ex vivo applications), who has hypercholesterolemia, orrelated diseases, a symptom of hypercholesterolemia, or relateddiseases, or the potential to develop hypercholesterolemia, or relateddiseases, with the purpose to cure, heal, alleviate, relieve, alter,remedy, ameliorate, improve or affect the hypercholesterolemia, orrelated diseases, the symptoms of hypercholesterolemia, or relateddiseases, or the potential to develop hypercholesterolemia, or relateddiseases. Such treatments may be specifically tailored or modified,based on knowledge obtained from the field of pharmacogenomics. As usedherein, to “treat” includes systemic amelioration of the symptomsassociated with the pathology and/or a delay in onset of symptoms.Clinical and sub-clinical evidence of “treatment” will vary with thepathology, the individual and the treatment.

As used herein, the term “prevent” or “preventing” comprises theprevention of at least one symptom associated with or caused by thestate, disease or disorder being prevented. As used herein, the term“prevent” or “prevention” also means no disorder or disease developmentif none had occurred, or no further disorder or disease development ifthere had already been development of the disorder or disease. Alsoconsidered is the ability of one to prevent some or all of the symptomsassociated with the disorder or disease.

As used herein, “inhibit” means to decrease an activity, such as theactivity of PCSK9 or the activity of a molecule that binds PCSK9.

As used herein, the term “patient,” “individual,” or “subject” refers toa human or a non-human mammal. Non-human mammals include, for example,livestock and pets, such as ovine, bovine, porcine, canine, feline andmarine mammals. Preferably, the patient, subject, or individual ishuman.

As used herein, the terms “effective amount,” “pharmaceuticallyeffective amount,” and “therapeutically effective amount” refer to anontoxic but sufficient amount of an agent to provide the desiredbiological result. That result may be reduction or alleviation of thesigns, symptoms, or causes of a disease, or any other desired alterationof a biological system. An appropriate therapeutic amount in anyindividual case can be determined by one of ordinary skill in the artusing routine experimentation.

As used herein, the term “pharmaceutically acceptable” refers to amaterial, such as a carrier or diluent, which does not abrogate thebiological activity or properties of the compound, and is relativelynon-toxic, i.e., the material may be administered to an individualwithout causing undesirable biological effects or interacting in adeleterious manner with any of the components of the composition inwhich it is contained.

As used herein, the term “composition” or “pharmaceutical composition”refers to a mixture of at least one compound useful within the inventionwith a pharmaceutically acceptable carrier. The pharmaceuticalcomposition facilitates administration of the compound to a patient orsubject. Multiple techniques of administering a compound exist in theart including, but not limited to, intravenous, oral, aerosol,parenteral, ophthalmic, pulmonary, and topical administration.

As used herein, the term “pharmaceutically acceptable carrier” means apharmaceutically acceptable material, composition or carrier, such as aliquid or solid filler, stabilizer, dispersing agent, suspending agent,diluent, excipient, thickening agent, solvent or encapsulating material,involved in carrying or transporting a compound useful within theinvention within or to the patient such that it may perform its intendedfunction. Typically, such constructs are carried or transported from oneorgan, or portion of the body, to another organ, or portion of the body.Each carrier must be “acceptable” in the sense of being compatible withthe other ingredients of the formulation, including the compound usefulwithin the invention, and not injurious to the patient. Some examples ofmaterials that may serve as pharmaceutically acceptable carriersinclude: sugars, such as lactose, glucose and sucrose; starches, such ascorn starch and potato starch; cellulose, and its derivatives, such assodium carboxymethyl cellulose, ethyl cellulose and cellulose acetate;powdered tragacanth; malt; gelatin; talc; excipients, such as cocoabutter and suppository waxes; oils, such as peanut oil, cottonseed oil,safflower oil, sesame oil, olive oil, corn oil and soybean oil; glycols,such as propylene glycol; polyols, such as glycerin, sorbitol, mannitoland polyethylene glycol; esters, such as ethyl oleate and ethyl laurate;agar; buffering agents, such as magnesium hydroxide and aluminumhydroxide; surface active agents; alginic acid; pyrogen-free water;isotonic saline; Ringer's solution; ethyl alcohol; phosphate buffersolutions; and other non-toxic compatible substances employed inpharmaceutical formulations.

As used herein, “pharmaceutically acceptable carrier” also includes anyand all coatings, antibacterial and antifungal agents, and absorptiondelaying agents, and the like that are compatible with the activity ofthe compound useful within the invention, and are physiologicallyacceptable to the patient. Supplementary active compounds may also beincorporated into the compositions. The “pharmaceutically acceptablecarrier” may further include a pharmaceutically acceptable salt of thecompound useful within the invention.

Other additional ingredients that may be included in the pharmaceuticalcompositions used in the practice of the invention are known in the artand described, for example in Remington's Pharmaceutical Sciences(Genaro, Ed., Mack Publishing Co., 1985, Easton, Pa.), which isincorporated herein by reference.

A “pharmaceutically acceptable salt” is intended to mean a salt of afree acid or base of the compounds provided herein that is non-toxic,biologically tolerable, or otherwise biologically suitable foradministration to the subject. It should possess the desiredpharmacological activity of the parent compound. See, generally, G. S.Paulekuhn, et al., “Trends in Active Pharmaceutical Ingredient SaltSelection based on Analysis of the Orange Book Database”, J. Med. Chem.,2007, 50:6665-72, S. M. Berge, et al., “Pharmaceutical Salts”, J PharmSci., 1977, 66:1-19, and Handbook of Pharmaceutical Salts, Properties,Selection, and Use, Stahl and Wermuth, Eds., Wiley-VCH and VHCA, Zurich,2002. Examples of pharmaceutically acceptable salts are those that arepharmacologically effective and suitable for contact with the tissues ofpatients without undue toxicity, irritation, or allergic response. Thecompounds provided herein may possess a sufficiently acidic group, asufficiently basic group, or both types of functional groups, andaccordingly react with a number of inorganic or organic bases, andinorganic and organic acids, to form a pharmaceutically acceptable salt.

As used herein, unnatural amino acids used in this invention have thefollowing amino acid code and structure:

Compounds

Provided herein are cyclic polypeptide compounds (also referred hereinas “compounds of the invention”) that are useful for inhibiting PCSK9activity. In one aspect, the compounds of the invention are useful forinhibiting the interaction between PCSK9 and EGF-A domain of LDLR in asubject. Additionally, the compounds of the invention are useful forreducing low density lipoprotein (LDL) cholesterol level in a subject.The subject whose LDL cholesterol is being lowered can suffer from adiagnosis of elevated LDL levels. The subject can also havehypercholesterolemia.

In another aspect, the compounds of the invention are useful fortreating or preventing hypercholesterolemia. In addition, the compoundsof the invention are useful for treating or preventing diseases thatshow comorbidity with hypercholesterolemia.

In another aspect, provided herein are cyclic peptides having thestructure of

Formula (0:

or a pharmaceutically acceptable salt thereof;

wherein:

A₁ is an acyl or sulfonyl protected NVA, or is an acyl protected amine;

R₄ is selected from the group consisting of the amino acid side chainsof THR, OMT, and ATHR;

R₅ is 7AW;

R₆ is selected from the group consisting of the amino acid side chainsof DAMA, DAMP, HOMP, APCA, AMMP, MEMP, AMPA, AZTC, GLU, and AIB;

R₇ is selected from the group consisting of the amino acid side chainsof GLU and ALA;

R₈ is selected from the group consisting of the amino acid side chainsof TYR and PPPP;

R₉ is 23B;

R₁₀ is selected from the group consisting of the amino acid side chainsof THR, OPPT, OPPS, SER, and LYS;

P₁ is H, methyl, an acetyl group, or

X is H or F;

n is 0 or 1;

p is 2, 3, or 4;

wherein each amino acid residue is optionally an N-methylated aminoacid; and

wherein each amino acid residue can be in the R or S configuration.

In an embodiment, the compound of Formula (I), or a pharmaceuticallyacceptable salt thereof, is selected from the following compounds ofTable 1 below:

TABLE 1

001

014

015

016

017

018

019

020

023

024

025

026

027

028

029

030

031

033

034

035

036

037

038

039

In another aspect, provided herein are cyclic peptides having thestructure of Formula (II):

or a pharmaceutically acceptable salt thereof;

wherein:

A₁ is an acyl or sulfonyl protected amino acid selected from the groupconsisting of NVA, UPPA, GUF, GMF, and HARG, or is an acyl protectedamine;

R₄ is THR;

R₅ is selected from the group consisting of the amino acid side chainsof 7AW, BPA, 3QA, GUF, NA3, and BTPA;

R₆ is selected from the group consisting of the amino acid side chainsof NVA, LEU, CHA, GLU, ALA, HSE, LYS, and AHHA;

R₇ is selected from the group consisting of the amino acid side chainsof GLU and NVA;

R₈ is selected from the group consisting of the amino acid side chainsof TYR and MTY;

R₉ is selected from the group consisting of the amino acid side chainsof CHG, NVA, TYR, HSE, AMP, and 23B;

R₁₀ is selected from the group consisting of the amino acid side chainsof THR, F2MA, and HSE;

P₁ is H, methyl, an acetyl group, or

n is 0 or 1;

p is 2, 3, 4, 5, or 6;

wherein each amino acid residue is optionally an N-methylated aminoacid; and

wherein each amino acid residue can be in the R or S configuration.

In an embodiment, the compound of Formula (II), or a pharmaceuticallyacceptable salt thereof, is selected from the following compounds ofTable 2 below:

TABLE 2

043

044

051

052

054

055

070

071

072

073

074

075

078

079

080

081

083

084

085

088

089

096

098

099

In another aspect, provided herein are cyclic peptides having thestructure of Formula (III):

or a pharmaceutically acceptable salt thereof;

wherein:

R₃ is selected from the group consisting of the amino acid side chainsof PRO and HIS;

R₆ is selected from the group consisting of the amino acid side chainsof NVA and AIB;

R₇ is selected from the group consisting of the amino acid side chainsof ALA and GLU or is covalently bound to R₃ by a linking moiety;

R₉ is selected from the group consisting of the amino acid side chainsof NVA, AIB, 23B, and CHG;

R₁₀ is the amino acid side chain of THR;

wherein each amino acid residue is optionally an N-methylated aminoacid;

wherein each amino acid residue can be in the R or S configuration; and

provided either R₃ and R₇, or R₆ and R₁₀ are covalently bound by alinking moiety selected from the group consisting of

In an embodiment of Formula (III), R₃ and R₇, or R₆ and R₁₀ arecovalently bound by a linking moiety selected from the group consistingof

In an embodiment, the compound of Formula (III), or a pharmaceuticallyacceptable salt thereof, is selected from the following compounds ofTable 3 below:

TABLE 3

101

106

107

108

109

110

111

112

114

115

118

119

120

In another aspect, the compounds of the invention are selected from thefollowing compounds of Table 4, or a pharmaceutically acceptable saltthereof, below:

TABLE 4

002

003

004

005

006

007

008

009

010

011

012

013

021

022

032

040

041

042

046

047

048

050

053

056

057

058

059

060

061

062

063

064

065

066

067

068

069

076

077

082

086

087

090

091

092

093

094

095

097

100

In another aspect, the compounds of the invention are selected from thefollowing compounds of Table 5, or a pharmaceutically acceptable saltthereof, below:

TABLE 5

103

104

105

116

117

102

045

049

The compounds of Formulae (I), (II), and (III), as well as compounds001-105, are referred to herein as “compounds of the invention.”

It is to be understood that the compounds described herein encompassracemic, optically-active, regioisomeric and stereoisomeric forms, orcombinations thereof that possess the therapeutically useful propertiesdescribed herein.

The preparation of optically active forms is achieved in any suitablemanner, including by way of non-limiting example, by resolution of theracemic form with recrystallization techniques, synthesis fromoptically-active starting materials, chiral synthesis, orchromatographic separation using a chiral stationary phase. In oneembodiment, a mixture of one or more isomer is utilized as the compoundof the invention described herein. In another embodiment, compoundsdescribed herein contain one or more chiral centers. These compounds areprepared by any means, including stereoselective synthesis,enantioselective synthesis or separation of a mixture of enantiomers ordiastereomers. Resolution of compounds and isomers thereof is achievedby any means including, by way of non-limiting example, chemicalprocesses, enzymatic processes, fractional crystallization,distillation, and chromatography.

Within the present disclosure, any open valency appearing on a carbon,oxygen, or nitrogen atom in any structure described herein indicates thepresence of a hydrogen atom. Where a chiral center exists in astructure, but no specific stereochemistry is shown for that center,both enantiomers, separately or as a mixture, are encompassed by thatstructure. The methods for the determination of stereochemistry and theseparation of stereoisomers are well-known in the art.

In embodiments, the compounds of the invention may exist as tautomers.All tautomers are included within the scope of the compounds presentedherein.

Compounds described herein also include isotopically-labeled compoundswherein one or more atoms is replaced by an atom having the same atomicnumber, but an atomic mass or mass number different from the atomic massor mass number usually found in nature. Examples of isotopes suitablefor inclusion in the compounds described herein include and are notlimited to ²H, ³H, ¹¹C, ¹³C, ¹⁴C, ³⁶Cl, ¹⁸F, ¹²³I, ¹²⁵I, ¹³N, ¹⁵O, ¹⁷O,¹⁸O, ³²P, and ³⁵S. Isotopically-labeled compounds are useful in drug orsubstrate tissue distribution studies. In another embodiment,substitution with heavier isotopes such as deuterium affords greatermetabolic stability (for example, increased in vivo half-life or reduceddosage requirements).

In yet another embodiment, substitution with positron emitting isotopes,such as ¹¹C, ¹⁸F, ¹⁵O, and ¹³N is useful in Positron Emission Topography(PET) studies for examining substrate receptor occupancy.Isotopically-labeled compounds are prepared by any suitable method or byprocesses using an appropriate isotopically-labeled reagent in place ofthe non-labeled reagent otherwise employed.

In one embodiment, the compounds described herein are labeled by othermeans, including, but not limited to, the use of chromophores orfluorescent moieties, bioluminescent labels, or chemiluminescent labels.

The compounds described herein, and other related compounds havingdifferent substituents are synthesized using techniques and materialsdescribed herein and as described, for example, in Fieser and Fieser'sReagents for Organic Synthesis, Volumes 1-17 (John Wiley and Sons,1991); Rodd's Chemistry of Carbon Compounds, Volumes 1-5 andSupplementals (Elsevier Science Publishers, 1989); Organic Reactions,Volumes 1-40 (John Wiley and Sons, 1991), Larock's Comprehensive OrganicTransformations (VCH Publishers Inc., 1989), March, Advanced OrganicChemistry 4th Ed., (Wiley 1992); Carey and Sundberg, Advanced OrganicChemistry 4th Ed., Vols. A and B (Plenum 2000, 2001), and Green andWuts, Protective Groups in Organic Synthesis 3rd Ed., (Wiley 1999) (allof which are incorporated by reference for such disclosure). Generalmethods for the preparation of compound as described herein are modifiedby the use of appropriate reagents and conditions, for the introductionof the various moieties found in the formula as provided herein.

Compounds described herein are synthesized using any suitable proceduresstarting from compounds that are available from commercial sources, orare prepared using procedures described herein.

Without being bound to any particular mechanism of action, the cyclicpolypeptide compounds provided herein can inhibit interaction betweenPCSK9 (e.g., human PCSK9) and LDLR (e.g., human LDLR) at an IC₅₀ of lessthan 50 μM, less than 45 μM, less than 40 μM, less than 35 μM, less than30 μM, less than 25 μM, less than 20 μM, less than 15 μM, less than 10μM, less than 9 μM, less than 8 μM, less than 7 μM, less than 6 μM, lessthan 5 μM, less than 4 μM, less than 3 μM, less than 2 μM, less than 1μM, less than 900 nM, less than 800 nM, less than 700 nM, less than 600nM, or less than 500 nM (e.g., as determined using the assay describedin the Examples). In any of these examples, the 1050 could be as low as10 nM, 25 nM, 50 nM, or 100 nM (e.g., as determined using the assaydescribed in the Examples). Additional methods for determining the IC₅₀of any of the compounds for inhibiting the interaction between PCSK9(e.g., human PCSK9) and LDLR (e.g., human LDLR) are known in the art.

Pharmaceutical Compositions

Also provided are pharmaceutical compositions comprising at least one(e.g., one, two, three, or four) of the cyclic polypeptide compoundsprovided herein. Two or more (e.g., two, three, or four) of any of thecyclic polypeptide compounds can be present in a pharmaceuticalcomposition in any combination. The pharmaceutical compositions may beformulated in any manner known in the art.

Pharmaceutical compositions for use in accordance with a methoddisclosed herein thus may be formulated in conventional manner using oneor more pharmaceutically acceptable carriers including excipients andauxiliaries that facilitate processing of the compound into preparationsthat can be used pharmaceutically. Proper formulation is dependent uponthe route of administration chosen.

In an embodiment, the administration of the pharmaceutical compositionis selected from the group consisting of oral, intravenous,intramuscular, intraperitoneal, subcutaneous, transdermal, andintravitreal.

In an embodiment, the pharmaceutical composition comprises at least oneof compounds of Formula (I), Formula (II), Formula (III), or compounds001-105 and a pharmaceutically acceptable carrier.

A pharmaceutical composition as disclosed herein comprises at least onecompound of the invention. Such a pharmaceutical composition may bemanufactured in a manner that is itself known, e.g., by means ofconventional mixing, dissolving, granulating, levigating, emulsifying,encapsulating, entrapping or lyophilizing processes.

For intravenous, intramuscular, intraperitoneal, subcutaneous,transdermal, and intravitreal administration, the agents disclosedherein may be formulated in aqueous solutions, for instance inphysiologically compatible buffers such as Hanks's solution, Ringer'ssolution, or physiological saline buffer. For transmucosaladministration, penetrants appropriate to the barrier to be permeatedare used in the formulation. Such penetrants are generally known in theart.

For oral administration, the compound can be formulated readily bycombining the compound with pharmaceutically acceptable carriers wellknown in the art. Such carriers enable the compounds of the invention tobe formulated as a tablet, pills, capsule, liquid, gel, syrup, slurry orsuspension, for oral ingestion by a subject to be treated.

Solid dosage forms can be prepared with coatings and shells, such asenteric coatings and others well-known in the art. They can containpacifying agents and can be of such composition that they release theactive compound or compounds in a certain part of the intestinal tractin a delayed manner. Examples of embedded compositions that can be usedare polymeric substances and waxes. The active compounds also can be inmicroencapsulated form, if appropriate, with one or more of theabove-mentioned excipients. For example, a pharmaceutical composition ofa compound of the invention can be encapsulated by a pharmaceuticalgrade capsule in a dry powdered form.

Compound formulations include controlled duodenal release formulations,time release formulations, osmotic-controlled release delivery systems,microemulsions, microspheres, liposomes, nanoparticles, patches, pumps,drug depots, and the like. Specifically included herein are solid oraldosage forms, such as powders, softgels, gelcaps, capsules, pills, andtablets.

In one embodiment, the peptide is formulated as a sterile aqueoussolution. In one embodiment, the peptide is formulated in a non-lipidformulation. In another embodiment, the peptide is formulated in acationic or non-cationic lipid formulation. In either embodiment, thesterile aqueous solution may contain additional active or inactivecomponents. Inactive components (“excipients”) can include, but are notlimited to, physiologically compatible salts, sugars, bulking agents,surfactants, or buffers.

Methods of Treatment

Provided herein is a method of reducing low density lipoprotein (LDL)cholesterol level in a subject in need thereof comprising administeringto the subject a therapeutically effective amount of a cyclicpolypeptide compound, or a pharmaceutical composition comprising acyclic polypeptide compound.

In an embodiment, the subject has hypercholesterolemia. Some subjects ofthe embodiment can be diagnosed as having a disease that showscomorbidity with hypercholesterolemia, such as nephrotic syndrome,kidney failure, coronary artery disease, atherosclerosis, stroke,peripheral vascular disease, diabetes, and high blood pressure.

In a further embodiment, the compound inhibits the interaction betweenhuman PCSK9 and epidermal growth factor-like repeat A (EGF-A) domain ofhuman low density lipoprotein (LDLR) in a subject.

In another embodiment, the compound inhibits the interaction betweenhuman PCSK9 and epidermal growth factor-like repeat A (EGF-A) domain ofhuman low density lipoprotein (LDLR) in a cell.

Also provided herein is a method of treating hypercholesterolemia in asubject in need thereof comprising administering to the subject atherapeutically effective amount of a compound of the invention.

Hypercholesterolemia is a disease characterized by the presence ofelevated levels of cholesterol (total cholesterol and/or LDL levels) ina sample obtained from a subject (e.g., as compared to a reference levelthat is a preselected threshold level). In some examples ofhypercholesterolemia, the subject can also have a decreased level ofhigh density lipoprotein (HDL) cholesterol as compared to a referencelevel, e.g., a preselected threshold level. Hypercholesterolemia istypically diagnosed by a medical professional by determining acholesterol level(s) in a subject. In a general patient population, apreselected threshold level of total cholesterol (LDL plus HDL) can be,e.g., 180 mg/dL, 185 mg/dL, 190 mg/dL, 195 mg/dL, 200 mg/dL, 205 mg/dL,210 mg/dL, 215 mg/dL, 220 mg/dL, 225 mg/dL, 230 mg/dL, 235 mg/dL, 240mg/dL, 245 mg/dL, 250 mg/dL, 255 mg/dL, or 260 mg/dL. In a generalpatient population, a preselected threshold level of LDL cholesterol canbe, e.g., 125 mg/dL, 130 mg/dL, 135 mg/dL, 140 mg/dL, 145 mg/dL, 150mg/dL, 155 mg/dL, 160 mg/dL, 165 mg/dL, 170 mg/dL, 175 mg/dL, 180 mg/dL,185 mg/dL, 190 mg/dL, 195 mg/dL, 200 mg/dL, 205 mg/mL, 210 mg/dL, 215mg/dL, 220 mg/dL, 225 mg/dL, or 230 mg/dL. In a general patientpopulation, a preselected threshold level of HDL cholesterol can be,e.g., 60 mg/dL, 58 mg/dL, 56 mg/dL, 54 mg/dL, 52 mg/dL, 50 mg/dL, 48mg/dL, 46 mg/dL, 44 mg/dL, 42 mg/dL, 40 mg/dL, 38 mg/dL, 36 mg/dL, 34mg/dL, 32 mg/dL, 30 mg/dL, 28 mg/dL, 26 mg/dL, or 24 mg/dL.

For subjects having a high risk of coronary disease (e.g., a subjecthaving greater than a 20% risk of myocardial infarction in 10 years, ora subject having coronary artery disease, diabetes, peripheral arterydisease, carotid artery disease, or aortic aneurysm), the preselectedthreshold level of LDL cholesterol can be, e.g., 60 mg/dL, 65 mg/dL, 70mg/dL, 75 mg/dL, 80 mg/dL, 85 mg/dL, 90 mg/dL, 95 mg/dL, or 100 mg/dL.For subjects having a moderately high risk of coronary disease (e.g., asubject having a 10% to 20% risk of myocardial infarction in 10 yearsand two or more risk factors of coronary disease), the preselectedthreshold level of LDL can be, e.g., 90 mg/dL, 95 mg/dL, 100 mg/dL, 105mg/dL, 110 mg/dL, 115 mg/dL, 120 mg/dL, 125 mg/dL, 130 mg/dL, 135 mg/dL,140 mg/dL, 145 mg/dL, or 150 mg/dL. For subjects having a moderate riskof coronary disease (e.g., a subject having a less than 10% risk ofhaving a myocardial infarction in 10 years and having greater than onerisk factor of coronary artery disease), the preselected threshold levelof LDL cholesterol can be, e.g., 115 mg/dL, 120 mg/dL, 125 mg/L, 130mg/dL, 135 mg/dL, 140 mg/L, 145 mg/dL, or 150 mg/dL. Risk factors ofcoronary disease include, but are not limited to, family history,smoking behavior, high blood pressure, diabetes, obesity, physicalinactivity, and high stress.

In any of the methods, the subject can be a subject having, diagnosed,or identified as having hypercholesterolemia, that is, for example,caused by diet and/or a genetic mutation (e.g., familialhypercholesterolemia) (e.g., any of the genetic mutations describedherein or known in the art to result in an increased LDL cholesterollevel).

In some of examples of any of the methods, the subject can be a subjecthaving, diagnosed, or identified as having a disease showing comorbiditywith hypercholesterolemia. Non-limiting examples of diseases showingcomorbidity with hypercholesterolemia include hypertension, heartdisease, arthritis, diabetes, coronary artery disease, stroke, breastcancer, and myocardial infarction.

Accordingly, provided herein is a method of treating a disease thatshows comorbidity with hypercholesterolemia such as nephrotic syndrome,kidney failure, coronary artery disease, atherosclerosis, stroke,peripheral vascular disease, diabetes, and high blood pressure, in asubject in need thereof comprising administering to the subject atherapeutically effective amount of a compound of the invention.

Methods for diagnosing hypertension, heart disease, arthritis, diabetes,coronary artery disease, stroke, breast cancer, and myocardialinfarction are well known in the art. For example, hypertension can bediagnosed in a subject by measuring the subject's blood pressure at oneor more time points. Heart disease can be diagnosed in a subject, e.g.,using blood tests, chest X-rays, electrocardiogram, echocardiography, anexercise stress test, radionuclide ventriculography, multiple-gatedacquisition scanning, or cardiac catheterization. Diabetes (type I ortype II) can be diagnosed, e.g., by measuring blood glucose level(s) ina subject (e.g., fasting blood glucose levels) and/or detecting ketonesin urine from the subject. Arthritis can be diagnosed in a subject,e.g., by physical examination for pain, stiffness, swelling, redness,and decreased range of motion in one or more joints, laboratory tests,X-rays, computerized tomography, magnetic resonance imaging, ultrasound,or athroscopy. Coronary artery disease can be diagnosed in a subject,e.g., by electrocardiogram, echocardiogram, stress test, cardiaccatheterization, angiogram, heart scan (e.g., using computerizedtomography), or magnetic resonance angiography. Stroke can be diagnosed,e.g., by examination, blood tests, computerized tomography, magneticresonance imaging, carotid ultrasound, cerebral angiogram, orechocardiogram. Breast cancer can be diagnosed, e.g., by breastexamination, mammogram, breast ultrasound, biopsy, or magnetic resonanceimaging. Myocardial infarction is diagnosed, e.g., by electrocardiogram,blood tests, chest X-ray, echocardiogram, coronary catheterization,exercise stress test, cardiac computerized tomography, or magneticresonance imaging. Provided are methods of treating a disease showingcomorbidity with hypercholesterolemia, where the methods includeadministering to a subject in need thereof (e.g., a subject havinghypercholesterolemia) a cyclic polypeptide compound or a pharmaceuticalcomposition provided herein. The administration reduces the risk ascompared to the risk of developing such a disease in a subject havingsimilar cholesterol levels but administered a different treatment oradministered no treatment. Also provided are methods of delaying theonset or delaying the worsening of a disease showing comorbidity withhypercholesterolemia, where the methods include administering to asubject in need thereof (e.g., a subject having hypercholesterolemia andoptionally, one or more risk factors of developing a disease showingcomorbidity with hypercholesterolemia, or a subject having, diagnosed ashaving, or identified as having a disease showing comorbidity withhypercholesterolemia) a compound or a pharmaceutical compositionprovided herein (e.g., as compared to a subject having the same diseaseshowing co-morbidity with hypercholesterolemia but administered adifferent treatment or administered no treatment).

Also provided are methods of reducing LDL cholesterol level in a subjectin need thereof that include administering to the subject atherapeutically effective amount of any of the compounds orpharmaceutical compositions described herein (the reducing being ascompared to, for example, a level in a control subject or a baselinelevel in the subject prior to treatment with any of the compounds or anyof the pharmaceutical compositions provided herein). Successfulreduction in a LDL cholesterol level in a subject can be determined by ahealth professional (e.g., a nurse, a physician, or a physician'sassistant). For example, successful treatment can result in at least a2%, at least a 3%, at least a 4%, at least a 5%, at least a 6%, at leasta 7%, at least a 8%, at least a 9%, at least a 10%, at least a 11%, atleast a 12%, at least a 13%, at least a 14%, at least a 15%, at least a16%, at least a 17%, at least a 18%, at least a 19%, at least a 20%, atleast a 21%, at least a 22%, at least a 23%, at least a 24%, at least a25%, at least a 26%, at least a 27%, at least a 28%, at least a 29%, orat least a 30% reduction in a subject's LDL cholesterol level (e.g., ascompared to a control subject or as compared to a LDL cholesterol levelin the subject prior to the administration of any of the compounds orany of the pharmaceutical compositions provided herein). In any of theseexamples, the reduction in a subject's LDL level can be as high as 40%,45%, 50%, 55%, 60%, or 65% (e.g., as compared to a control subject or ascompared to a LDL cholesterol level in the subject prior to theadministration of any of the compounds or any of the pharmaceuticalcompositions provided herein). In addition, the methods can furtherprovide for a reduction in the total cholesterol level of a subject,e.g., a reduction of at least 2%, at least 3%, at least 4%, at least 5%,at least 6%, at least 7%, at least 8%, at least 9%, at least 10%, atleast 11%, at least 12%, at least 13%, at least 14%, or at least 15%(e.g., as compared to a control subject or compared to a totalcholesterol level in the subject prior to the administration of any ofthe compounds or any of the pharmaceutical compositions providedherein). In any of these examples, the reduction in a subject's totalcholesterol level can be as high as 40%, 45%, 50%, 55%, 60%, or 65%(e.g., as compared to a control subject or compared to a totalcholesterol level in the subject prior to the administration of any ofthe compounds or any of the pharmaceutical compositions providedherein).

Methods for determining levels of LDL cholesterol and total cholesterolare well known in the art. Non-limiting examples of kits for determiningthe levels of LDL cholesterol and total cholesterol are commerciallyavailable from Abcam (Cambridge, Mass.), Sigma Aldrich (St. Louis, Mo.),Cell Biolabs, Inc. (San Diego, Calif.), Genway Biotech (San Diego,Calif.), Biolabo (Lawrenceville, Ga.), BioAssay Systems (Hayward,Calif.), Medibena (Vienna, Austria), and Abnova (Taipei, Taiwan).

The subject in these methods can, e.g., be a subject having, diagnosedas having, or identified as having hypercholesterolemia (e.g., familialhypercholesterolemia) or a subject identified or previously identifiedas having an increased risk of developing hypercholesterolemia. In someexamples, the subject in these methods can be, e.g., a subject having,diagnosed as having, or identified as having a disease showingcomorbidity with hypercholesterolemia (e.g., any of the examples ofdiseases showing comorbidity with hypercholesterolemia described hereinor known in the art). Also provided are methods of reducing the risk ofdeveloping a disease showing comorbidity with hypercholesterolemia(e.g., as compared to the risk in a control patient or patientpopulation that has not received treatment with any of the compounds orhas not received any of the pharmaceutical compositions provided herein)that include administering to a subject in need thereof a compound or apharmaceutical composition provided herein. The subject in these methodscan be a subject having, diagnosed as having, or identified as havinghypercholesterolemia or identified or previously identified as having anincreased risk of developing hypercholesterolemia. In some examples, thesubject can be identified or previously identified as having anincreased risk of developing a disease showing comorbidity withhypercholesterolemia (e.g., a subject having one or more risk factorsfor developing a disease showing comorbidity with hypercholesterolemiaor having one or more risk factors for developing hypercholesterolemia).

In some examples, the subject may already be receiving or have receiveda treatment for hypercholesterolemia (e.g., a statin, niacin, bile-acidresins, fibrates, and cholesterol adsorption inhibitors). In someexamples, the prior treatment for hypercholesterolemia resulted in nosignificant reduction in LDL cholesterol level in the subject in needthereof (e.g., any of the subjects descried herein), and/or insufficientreduction in the LDL cholesterol level in the subject (e.g., any of thesubjects described herein) (i.e., not sufficient to reduce LDLcholesterol level to below a reference level that is a preselectedthreshold level).

In some embodiments, the subject is administered a dose of between 1 mgto 400 mg of any of the compounds or any of the pharmaceuticalcompositions (e.g., between 1 mg and 300 mg, between 1 mg and 250 mg,between 1 mg and 200 mg, between 1 mg and 150 mg, between 1 mg and 100mg, between 1 mg and 80 mg, between 1 mg and 70 mg, between 1 mg and 60mg, between 1 mg and 50 mg, between 1 mg and 40 mg, between 1 mg and 30mg, between 1 mg and 20 mg, between 1 mg and 10 mg, between 20 mg and120 mg, between 30 mg and 90 mg, or between 40 mg and 80 mg). In someexamples, the subject is administered a dose of the compound orpharmaceutical composition described herein of about 0.1 mg/kg to about4.0 mg/kg (e.g., between about 0.1 mg/kg and about 3.5 mg/kg, betweenabout 0.1 mg/kg and about 3.0 mg/kg, between about 0.1 mg/kg and about2.5 mg/kg, between about 0.1 mg/kg and about 2.0 mg/kg, between about0.1 mg/kg and about 1.5 mg/kg, between about 0.5 mg/kg and about 1.5mg/kg, or between about 0.7 mg/kg and about 1.3 mg/kg).

Also provided are methods of inhibiting the interaction between PCSK9(e.g., any of the exemplary mammalian PCSK9 described herein, such ashuman PCSK9) and LDLR (e.g., any of the exemplary mammalian LDLRdescribed herein, such as human LDLR) that include contacting PCSK9 andLDLR with any of the compounds or pharmaceutical compositions providedherein (e.g., the inhibition being compared to, for example, a level ofinteraction between PCSK9 and LDLR in the absence of the compounds orpharmaceutical composition). In some examples, the contacting takesplace in vitro (e.g., in a cell culture). In other examples, thecontacting takes place in vivo (e.g., in any of the exemplary subjectsdescribed herein or any of the animal models described herein). In anyof these methods, LDLR can be present in the plasma membrane of amammalian cell (e.g., a hepatocyte, an epithelial cell, or anendothelial cell), and oriented in the plasma membrane such that LDLRcan interact with PCSK9 present in an extracellular medium (e.g.,culture medium).

Non-limiting methods for detecting the interaction (or amount ofinteraction) between PCSK9 and LDLR are described herein. For example,LDLR can be attached to a solid substrate (e.g., a plate, film, or abead) (e.g., in such a way that allows LDLR to interact with PCSK9) andcontacted with PCSK9 in the presence or absence of any of the compoundsor pharmaceutical compositions described herein, and the amount of PCSK9bound to the LDLR in the presence of the compound or pharmaceuticalcomposition can be compared to the amount bound in a control assay thatdoes not include the compound or pharmaceutical composition. Detectingthe amount of PCSK9 bound to LDLR in the presence or absence of thecompound or pharmaceutical composition can be performed byimmunoprecipitation and immunoblotting, surface plasmon resonance, ortime-resolved fluorescence energy transfer (TR-FRET).

As is known in the art, an inhibition of the interaction between PCSK9and LDLR can be measured as an increase in the K_(D) value and/or adecrease in K_(A) value for the interaction between PCSK9 (e.g., humanPCSK9) and LDLR (e.g., human LDLR) (e.g., the EGF-A domain of LDLR) inthe presence of any of the compounds or pharmaceutical compositionsprovided herein (e.g., as compared to levels of interaction in theabsence of the compound or pharmaceutical composition).

The interaction between PCSK9 and LDLR can be indirectly detected whenthe interaction between PCSK9 and LDLR occurs in vitro. For example,interaction between PCSK9 and LDLR, where the LDLR is expressed in theplasma membrane of a hepatocyte, can be indirectly detected bydetermining the amount of LDLR remaining in the hepatocyte it has beencontacted with PCSK9 in the presence or absence of any the compounds orpharmaceutical compositions provided herein (where a higher level ofLDLR in the hepatocyte after incubation in the presence of the compoundor pharmaceutical composition as compared to the level of LDLR in thehepatocyte after incubation in the absence of the compound orpharmaceutical composition indicates that the interaction between LDLRand PCSK9 has been inhibited).

The amount of inhibition of the interaction between LDLR and PCSK9 invivo can also be indirectly determined by measuring the level of LDLcholesterol in a subject administered the compound or pharmaceuticalcomposition as compared to a control level of LDL (e.g., a level of LDLcholesterol in the same subject prior to treatment with the compound orpharmaceutical composition). In such an assay, a decreased level of LDLcholesterol in the subject after treatment, as compared to the level ofLDL cholesterol in the subject before treatment, indicates that thecompound or pharmaceutical composition administered to the subjectinhibited the interaction between PCSK9 and LDLR in the subject.

In an embodiment of these methods, the administration is selected fromthe group consisting of oral, intravenous, intramuscular,intraperitoneal, subcutaneous, transdermal, and intravitreal.

In an embodiment of these methods, provided herein is a method oftreating hypercholesterolemia in a subject in need thereof comprisingadministering to the subject at least one of compounds of Formula (I),Formula (II), Formula (III), or compounds 001-105 or a pharmaceuticallycomposition comprising at least one of compounds of Formula (I), Formula(II), Formula (III), or compounds 001-105.

It is to be understood that the methods described in this disclosure arenot limited to particular methods and experimental conditions disclosedherein, as such methods and conditions may vary. It is also to beunderstood that the terminology used herein is for the purpose ofdescribing particular embodiments only, and is not intended to belimiting. Furthermore, the experiments described herein, unlessotherwise indicated, use conventional molecular and cellular biologicaland immunological techniques within the skill of the art. Suchtechniques are well known to the skilled worker, and are explained fullyin the literature. See, e.g., Ausubel, et al., ed., Current Protocols inMolecular Biology, John Wiley & Sons, Inc., NY, N.Y. (1987-2008),including all supplements, Molecular Cloning: A Laboratory Manual(Fourth Edition) by MR Green and J. Sambrook and Harlow et al.,Antibodies: A Laboratory Manual, Chapter 14, Cold Spring HarborLaboratory, Cold Spring Harbor (2013, 2nd edition).

Unless otherwise defined herein, scientific and technical terms usedherein have the meanings that are commonly understood by those ofordinary skill in the art. In the event of any latent ambiguity,definitions provided herein take precedent over any dictionary orextrinsic definition. Unless otherwise required by context, singularterms shall include pluralities and plural terms shall include thesingular. The use of “or” means “and/or” unless stated otherwise. Theuse of the term “including,” as well as other forms, such as “includes”and “included,” is not limiting. As used herein, unless otherwisestated, the singular forms “a,” “an,” and “the” include pluralreference. Thus, for example, a reference to “a protein” includes aplurality of protein molecules.

Generally, nomenclatures used in connection with cell and tissueculture, molecular biology, immunology, microbiology, genetics andprotein and nucleic acid chemistry and hybridization described hereinare those well-known and commonly used in the art. The methods andtechniques provided herein are generally performed according toconventional methods well known in the art and as described in variousgeneral and more specific references that are cited and discussedthroughout the present specification unless otherwise indicated.Enzymatic reactions and purification techniques are performed accordingto manufacturer's specifications, as commonly accomplished in the art oras described herein. The nomenclatures used in connection with, and thelaboratory procedures and techniques of, analytical chemistry, syntheticorganic chemistry, and medicinal and pharmaceutical chemistry describedherein are those well-known and commonly used in the art. Standardtechniques are used for chemical syntheses, chemical analyses,pharmaceutical preparation, formulation, and delivery, and treatment ofpatients.

It will be readily apparent to those skilled in the art that othersuitable modifications and adaptations of the methods described hereinmay be made using suitable equivalents without departing from the scopeof the embodiments disclosed herein. Having now described certainembodiments in detail, the same will be more clearly understood byreference to the following examples, which are included for purposes ofillustration only and are not intended to be limiting.

EXAMPLES

The invention is now described with reference to the following Examples.These Examples are provided for the purpose of illustration only, andthe invention is not limited to these Examples, but rather encompassesall variations that are evident as a result of the teachings providedherein.

Compounds of the invention can be prepared according to the followingexamples.

Example 1: Synthesis of Cyclic Polypeptide Compounds Procedure A Step 1:Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-aminoethanethioI-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a CEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Deprotection and Cyclization

The peptide from Step 1 was not cleaved from the resin. The resin-boundpeptide was transferred to a 15 mL polypropylene centrifuge tube. Todeprotect the alloc/allyl protecting groups, the resin was treated witha solution of tetrakis(triphenylphosphine) palladium (0) (55 mg, 0.05mmol) and phenylsilane (125 μL, 1.0 mmol) in dry DCM (degassed bybubbling N2 gas for 5 min). The reaction vessel was rocked at roomtemperature for 2 h (released the pressure every 15 min). The solutionwas drained and the resin washed with DCM (3×5 mL). The deprotectionstep was repeated, after which the resin was washed with DCM (5×5 mL),DMF (5×5 mL), 1 M diethyldithiocarbamic acid sodium salt in DMF (2×5mL), DMF (5×5 mL), and DCM (2×5 mL).

A solution of PyAOP (105 mg, 0.2 mmol;(7-Azabenzotriazol-1-yloxy)tripyrrolidino-phosphoniumhexafluorophosphate), HOAt (14 mg, 0.1 mmol; 1-Hydroxy azabenzotriazole)and DIPEA (90 μL, 0.5 mmol) in DMF (5 mL) was then added to the resinand the mixture shaken for 3 h at room temperature. The solution wasdrained and the resin washed with DMF (3×5 mL) and DCM (3×5 mL). Thecyclization step was repeated for 12 h, after which the resin was washedwith DMF (5×5 mL) and DCM (5×5 mL) and dried. The resultant product wasused directly in the next step.

Step 3: Cleavage from Solid-Support

The resin from Step 2 was transferred to either a 50 mL polypropylenecentrifuge tube or a 10 mL fritted syringe. The peptides were cleavedfrom their solid support using trifluoroaceticacid/triisopropylsilane/DL-dithiothreitol/water (92.5/2.5/2.5 (w/v)/2.5)mixture. For 0.1 mmol scale of resin, ˜10 mL cleavage solution was used.The suspended resin was rocked in cleavage solution for 3 hours at roomtemperature. The filtrate was collected in 50 mL polypropylenecentrifuge tubes and precipitated with chilled diethyl ether (˜50 mL per˜5 mL cleavage filtrate). The precipitated crude peptide was collectedby centrifugation. The white pellet was then subsequently suspended inchilled diethyl ether and collected by centrifugation two additionaltimes. The resulting solid was air-dried to afford the crude peptide.

Step 4: Cyclization

For a 0.1 mmol scale: The linear peptide was synthesized, cleaved fromsolid support, and isolated according to Step 3. The solid crude peptidewas dissolved with stirring in 30 mL of a degassed water:acetonitrile(1:1) solution in a 50 mL polypropylene centrifuge tube. Additionalacetonitrile was added as needed to ensure complete dissolution of thepeptide. To this stirred solution, aqueous ammonium bicarbonate (200 mM,degassed) was added dropwise to bring the pH to ˜8. Alkylating reagent1,3-bis(bromomethyl)benzene (0.1 mmol/1 eq) in acetonitrile (1 mL) wasadded dropwise to the reaction over ˜2 min. After complete addition, thereaction was tested to ensure the pH was maintained at ˜8. If the pH wasbelow ˜8, additional aqueous ammonium bicarbonate (200 mM, degassed) wasadded dropwise to the reaction until the pH was ˜8. The centrifuge tubewas capped and the resulting reaction mixture was stirred at roomtemperature for 1 h. The reaction was then acidified to pH ˜1 withtrifluoroacetic acid and lyophilized to afford the crude peptide as apowder. The desired product was purified by C18 reverse phasechromatography.

Procedure A1 Step 1: Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-aminoethanethiol-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a CEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Deprotection and Cyclization

The peptide from Step 1 was not cleaved from the resin. The resin-boundpeptide was transferred to a 15 mL polypropylene centrifuge tube. Todeprotect the alloc/allyl protecting groups, the resin was treated witha solution of tetrakis(triphenylphosphine) palladium (0) (55 mg, 0.05mmol) and phenylsilane (125 μL, 1.0 mmol) in dry DCM (degassed bybubbling N2 gas for 5 min). The reaction vessel was rocked at roomtemperature for 2 h (released the pressure every 15 min). The solutionwas drained and the resin washed with DCM (3×5 mL). The deprotectionstep was repeated, after which the resin was washed with DCM (5×5 mL),DMF (5×5 mL), 1 M diethyldithiocarbamic acid sodium salt in DMF (2×5mL), DMF (5×5 mL), and DCM (2×5 mL).

A solution of PyAOP (105 mg, 0.2 mmol;(7-Azabenzotriazol-1-yloxy)tripyrrolidino-phosphoniumhexafluorophosphate), HOAt (14 mg, 0.1 mmol;1-Hydroxy-7-azabenzotriazole) and DIPEA (90 μL, 0.5 mmol) in DMF (5 mL)was then added to the resin and the mixture shaken for 3 h at roomtemperature. The solution was drained and the resin washed with DMF (3×5mL) and DCM (3×5 mL). The cyclization step was repeated for 12 h, afterwhich the resin was washed with DMF (5×5 mL) and DCM (5×5 mL) and dried.The resultant product was used directly in the next step.

Step 3: Cleavage from Solid-Support

The resin from Step 2 was transferred to either a 50 mL polypropylenecentrifuge tube or a 10 mL fritted syringe. The peptides were cleavedfrom their solid support using trifluoroaceticacid/triisopropylsilane/DL-dithiothreitol/water (92.5/2.5/2.5 (w/v)/2.5)mixture. For 0.1 mmol scale of resin, ˜10 mL cleavage solution was used.The suspended resin was rocked in cleavage solution for 3 hours at roomtemperature. The filtrate was collected in 50 mL polypropylenecentrifuge tubes and precipitated with chilled diethyl ether (˜50 mL per˜5 mL cleavage filtrate). The precipitated crude peptide was collectedby centrifugation. The white pellet was then subsequently suspended inchilled diethyl ether and collected by centrifugation two additionaltimes. The resulting solid was air-dried to afford the crude peptide.

Step 4: Cyclization

To a 250 mL round-bottomed flask fitted with a stir bar, was added PyAOP(210 mg, 0.4 mmol; (7-Azabenzotriazol-1-yloxy)tripyrro-lidinophosphoniumhexafluorophosphate), HOAt (14 mg, 0.1 mmol;1-Hydroxy-7-azabenzotriazole) and DIPEA (90 μL, 0.5 mmol) in DMF (80mL). The precipitated solid crude peptide from Step 3 was dissolved inDMF (25 mL) and added dropwise to the activator solution using a syringepump (addition over 1.5 h). The resulting yellow solution was stirredovernight at room temperature. After completion of the cyclization(monitored by LCMS), the reaction mixture was acidified by addition ofTFA (100 μL). DMF solvent was evaporated under high vacuum and theresulting crude residue was purified by C18 reverse-phase HPLC.

Procedure B Step 1: Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-aminoethanethiol-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a OEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Olefin Metathesis

For a 0.1 mmol scale: The linear peptide was synthesized onsolid-support according to Step 1. The peptide was not cleaved fromresin. A solution ofBenzylidene-bis(tricyclohexylphosphine)-dichlororuthenium (Grubb'sgeneration I catalyst) was prepared by dissolving 16 mg (0.2 equiv)(based on peptide resin of 0.1 mmol) in anhydrous 1,2-dichloroethane (5mL). The solution was degassed by bubbling nitrogen through the solutionfor 10 minutes. The degassed solution was then added to the resin-boundpeptide in a 10 mL fritted syringe. The reaction was allowed to proceedat 45° C. for two hours and then the catalyst was filtered off. Theresin was then re-subjected to the metathesis conditions by adding anadditional 5 mL of freshly-prepared catalyst solution (16 mg Grubb'sgeneration I catalyst in 5 mL of degassed anhydrous 1,2-dichloroethane).The reaction was allowed to proceed for 2 hours at 45° C. Theresin-bound peptide was then washed with dichloromethane (5×10 mL). Thereaction can be monitored for completion by removing a few beads,cleaving the peptide (95% TFA/2.5% H₂O/2.5% triisopropylsilane) andanalyzing by LCMS.

Step 3: Cleavage from Solid-Support

The resin from Step 2 was transferred to either a 50 mL polypropylenecentrifuge tube or a 10 mL fritted syringe. The peptides were cleavedfrom their solid support using trifluoroaceticacid/triisopropylsilane/DL-dithiothreitol/water (92.5/2.5/2.5 (w/v)/2.5)mixture. For 0.1 mmol scale of resin, ˜10 mL cleavage solution was used.The suspended resin was rocked in cleavage solution for 3 hours at roomtemperature. The filtrate was collected in 50 mL polypropylenecentrifuge tubes and precipitated with chilled diethyl ether (˜50 mL per˜5 mL cleavage filtrate). The precipitated crude peptide was collectedby centrifugation. The white pellet was then subsequently suspended inchilled diethyl ether and collected by centrifugation two additionaltimes. The resulting solid was air-dried to afford the crude peptide.

Step 4: Cyclization

To a 250 mL round-bottomed flask fitted with a stir bar, was added PyAOP(210 mg, 0.4 mmol; (7-Azabenzotriazol-1-yloxy)tripyrro-lidinophosphoniumhexafluorophosphate), HOAt (14 mg, 0.1 mmol;1-Hydroxy-7-azabenzotriazole) and DIPEA (90 μL, 0.5 mmol) in DMF (80mL). The precipitated solid crude peptide from Step 3 was dissolved inDMF (25 mL) and added dropwise to the activator solution using a syringepump (addition over 1.5 h). The resulting yellow solution was stirredovernight at room temperature. After completion of the cyclization(monitored by LCMS), the reaction mixture was acidified by addition ofTFA (100 μL). DMF solvent was evaporated under high vacuum and theresulting crude residue was purified by C18 reverse-phase HPLC.

Procedure D Step 1: Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-aminoethanethioI-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a CEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Olefin Metathesis

For a 0.1 mmol scale: The linear peptide was synthesized onsolid-support according to Step 1. The peptide was not cleaved fromresin. A solution ofBenzylidene-bis(tricyclohexylphosphine)-dichlororuthenium (Grubb'sgeneration I catalyst) was prepared by dissolving 16 mg (0.2 equiv)(based on peptide resin of 0.1 mmol) in anhydrous 1,2-dichloroethane (5mL). The solution was degassed by bubbling nitrogen through the solutionfor 10 minutes. The degassed solution was then added to the resin-boundpeptide in a 10 mL fritted syringe. The reaction was allowed to proceedat 45° C. for two hours and then the catalyst was filtered off. Theresin was then re-subjected to the metathesis conditions by adding anadditional 5 mL of freshly-prepared catalyst solution (16 mg Grubb'sgeneration I catalyst in 5 mL of degassed anhydrous 1,2-dichloroethane).The reaction was allowed to proceed for 2 hours at 45° C. Theresin-bound peptide was then washed with dichloromethane (5×10 mL). Thereaction can be monitored for completion by removing a few beads,cleaving the peptide (95% TFA/2.5% H₂O/2.5% triisopropylsilane) andanalyzing by LCMS.

Step 3: Cleavage from Solid-Support

The resin from Step 2 was transferred to either a 50 mL polypropylenecentrifuge tube or a 10 mL fritted syringe. The peptides were cleavedfrom their solid support using trifluoroaceticacid/triisopropylsilane/DL-dithiothreitol/water (92.5/2.5/2.5 (w/v)/2.5)mixture. For 0.1 mmol scale of resin, ˜10 mL cleavage solution was used.The suspended resin was rocked in cleavage solution for 3 hours at roomtemperature. The filtrate was collected in 50 mL polypropylenecentrifuge tubes and precipitated with chilled diethyl ether (˜50 mL per˜5 mL cleavage filtrate). The precipitated crude peptide was collectedby centrifugation. The white pellet was then subsequently suspended inchilled diethyl ether and collected by centrifugation two additionaltimes. The resulting solid was air-dried to afford the crude peptide.

Step 4: Cyclization

For a 0.1 mmol scale: The linear peptide was synthesized, cleaved fromsolid support, and isolated according to Step 3. The solid crude peptidewas dissolved with stirring in 30 mL of a degassed water:acetonitrile(1:1) solution in a 50 mL polypropylene centrifuge tube. Additionalacetonitrile was added as needed to ensure complete dissolution of thepeptide. To this stirred solution, aqueous ammonium bicarbonate (200 mM,degassed) was added dropwise to bring the pH to ˜8. Alkylating reagent1,3-bis(bromomethyl)benzene (0.1 mmol/1 eq) in acetonitrile (1 mL) wasadded dropwise to the reaction over ˜2 min. After complete addition, thereaction was tested to ensure the pH was maintained at ˜8. If the pH wasbelow ˜8, additional aqueous ammonium bicarbonate (200 mM, degassed) wasadded dropwise to the reaction until the pH was ˜8. The centrifuge tubewas capped and the resulting reaction mixture was stirred at roomtemperature for 1 h. The reaction was then acidified to pH ˜1 withtrifluoroacetic acid and lyophilized to afford the crude peptide as apowder. The desired product was purified by C18 reverse phasechromatography.

Procedure E: Step 1: Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-AminoethanethioI-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a CEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Cleavage from Solid-Support

The resin from Step 1 was transferred to either a 50 mL polypropylenecentrifuge tube or a 10 mL fritted syringe. The peptides were cleavedfrom their solid support using trifluoroaceticacid/triisopropylsilane/DL-dithiothreitol/water (92.5/2.5/2.5 (w/v)/2.5)mixture. For 0.1 mmol scale of resin, ˜10 mL cleavage solution was used.The suspended resin was rocked in cleavage solution for 3 hours at roomtemperature. The filtrate was collected in 50 mL polypropylenecentrifuge tubes and precipitated with chilled diethyl ether (˜50 mL per˜5 mL cleavage filtrate). The precipitated crude peptide was collectedby centrifugation. The white pellet was then subsequently suspended inchilled diethyl ether and collected by centrifugation two additionaltimes. The resulting solid was air-dried to afford the crude peptide.

Step 3: Cyclization

For a 0.1 mmol scale: The linear peptide was synthesized, cleaved fromsolid support, and isolated according to Step 2. The solid crude peptidewas dissolved with stirring in 30 mL of a degassed water:acetonitrile(1:1) solution in a 50 mL polypropylene centrifuge tube. Additionalacetonitrile was added as needed to ensure complete dissolution of thepeptide. To this stirred solution, aqueous ammonium bicarbonate (200 mM,degassed) was added dropwise to bring the pH to ˜8. Alkylating reagent1,3-bis(bromomethyl)benzene (0.1 mmol/1 eq) in acetonitrile (1 mL) wasadded dropwise to the reaction over ˜2 min. After complete addition, thereaction was tested to ensure the pH was maintained at ˜8. If the pH wasbelow ˜8, additional aqueous ammonium bicarbonate (200 mM, degassed) wasadded dropwise to the reaction until the pH was ˜8. The centrifuge tubewas capped and the resulting reaction mixture was stirred at roomtemperature for 1 h. The reaction was then acidified to pH ˜1 withtrifluoroacetic acid and lyophilized to afford the crude peptide as apowder. The desired product was purified by C18 reverse phasechromatography.

Procedure E1: Step 1: Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-AminoethanethioI-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a CEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Deprotection and Derivatization

The peptide from Step 1 was not cleaved from the resin. To deprotect theDDe protecting groups, the resin was treated with 15 ml of a solution of2% of hydrazine. The solution was drained and the resin washed with DCM(3×5 mL). The deprotection step was repeated, after which the resin waswashed with DCM (5×5 mL), DMF (5×5 mL). Side chain derivatization wasperformed by manual coupling. Typical reaction conditions were asfollows: Deprotection Conditions: 20% piperidine (v/v) in DMF (2×15min); Residue Coupling Conditions: 5 eq (relative to resin) of aminoacid (0.1M in DMF) was delivered to the resin, followed by 5 eq of DICand 5 eq of HOAt (0.1M solution in DMF) and allowed to react for 60 minat 25° C. The resultant product was used directly in the next step.Step 3: Cleavage from Solid-Support

The resin from Step 1 was transferred to either a 50 mL polypropylenecentrifuge tube or a 10 mL fritted syringe. The peptides were cleavedfrom their solid support using trifluoroaceticacid/triisopropylsilane/DL-dithiothreitol/water (92.5/2.5/2.5 (w/v)/2.5)mixture. For 0.1 mmol scale of resin, ˜10 mL cleavage solution was used.The suspended resin was rocked in cleavage solution for 3 hours at roomtemperature. The filtrate was collected in 50 mL polypropylenecentrifuge tubes and precipitated with chilled diethyl ether (˜50 mL per˜5 mL cleavage filtrate). The precipitated crude peptide was collectedby centrifugation. The white pellet was then subsequently suspended inchilled diethyl ether and collected by centrifugation two additionaltimes. The resulting solid was air-dried to afford the crude peptide.

Step 4: Cyclization

For a 0.1 mmol scale: The linear peptide was synthesized, cleaved fromsolid support, and isolated according to Step 2. The solid crude peptidewas dissolved with stirring in 30 mL of a degassed water:acetonitrile(1:1) solution in a 50 mL polypropylene centrifuge tube. Additionalacetonitrile was added as needed to ensure complete dissolution of thepeptide. To this stirred solution, aqueous ammonium bicarbonate (200 mM,degassed) was added dropwise to bring the pH to ˜8. Alkylating reagent1,3-bis(bromomethyl)benzene (0.1 mmol/1 eq) in acetonitrile (1 mL) wasadded dropwise to the reaction over ˜2 min. After complete addition, thereaction was tested to ensure the pH was maintained at ˜8. If the pH wasbelow ˜8, additional aqueous ammonium bicarbonate (200 mM, degassed) wasadded dropwise to the reaction until the pH was ˜8. The centrifuge tubewas capped and the resulting reaction mixture was stirred at roomtemperature for 1 h. The reaction was then acidified to pH ˜1 withtrifluoroacetic acid and lyophilized to afford the crude peptide as apowder. The desired product was purified by C18 reverse phasechromatography.

Procedure F: Step 1: Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-AminoethanethioI-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a OEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Cleavage from Solid-Support The resin from Step 1 wastransferred to either a 50 mL polypropylene centrifuge tube or a 10 mLfritted syringe. The peptides were cleaved from their solid supportusing trifluoroacetic acid/triisopropylsilane/DL-dithiothreitol/water(92.5/2.5/2.5 (w/v)/2.5) mixture. For 0.1 mmol scale of resin, ˜10 mLcleavage solution was used. The suspended resin was rocked in cleavagesolution for 3 hours at room temperature. The filtrate was collected in50 mL polypropylene centrifuge tubes and precipitated with chilleddiethyl ether (˜50 mL per ˜5 mL cleavage filtrate). The precipitatedcrude peptide was collected by centrifugation. The white pellet was thensubsequently suspended in chilled diethyl ether and collected bycentrifugation two additional times. The resulting solid was air-driedto afford the crude peptide.

Step 3: Cyclization

To a 250 mL round-bottomed flask fitted with a stir bar, was added PyAOP(210 mg, 0.4 mmol; (7-Azabenzotriazol-1-yloxy)tripyrro-lidinophosphoniumhexafluorophosphate), HOAt (14 mg, 0.1 mmol;1-Hydroxy-7-azabenzotriazole) and DIPEA (90 μL, 0.5 mmol) in DMF (80mL). The precipitated solid crude peptide from Step 3 was dissolved inDMF (25 mL) and added dropwise to the activator solution using a syringepump (addition over 1.5 h). The resulting yellow solution was stirredovernight at room temperature. After completion of the cyclization(monitored by LCMS), the reaction mixture was acidified by addition ofTFA (100 μL). DMF solvent was evaporated under high vacuum and theresulting crude residue was purified by C18 reverse-phase HPLC.

Procedure K: Step 1: Peptide Synthesis

The peptides were synthesized using Fmoc-protected amino acids on asolid-phase Rink Amide MBHA (NovaBiochem, ˜0.5 meq/g, 100-200 mesh) orAM (NovaBiochem, ˜0.73 meq/g, 100-200 mesh) or2-AminoethanethioI-2-chlorotrityl resin (AnaSpec, ˜0.9 meq/g, 200-400mesh) with a CEM Liberty Blue automated microwave peptide synthesizer.Peptides were typically synthesized on a 0.1 mmol scale. Typicalreaction conditions were as follows: Deprotection Conditions: 20%piperidine (v/v) in DMF (2×2 min at 75° C.); Residue CouplingConditions: 5 eq (relative to resin) of activated amino acid (2.5 mL ofa 0.2 M amino acid stock solution in DMF) was delivered to the resin,followed by 5 eq of DIC activator (1 mL of a 0.5 M solution in DMF), and5 eq of Oxyma Pure (0.5 mL of a 1 M solution in DMF) and allowed toreact for 5 min at 75° C. The resultant product was used directly in thenext step.

Step 2: Deprotection and Cyclization

The peptide from Step 1 was not cleaved from the resin. The resin-boundpeptide was transferred to a 15 mL polypropylene centrifuge tube. Todeprotect the alloc/allyl protecting groups, the resin was treated witha solution of tetrakis(triphenylphosphine) palladium (0) (55 mg, 0.05mmol) and phenylsilane (125 μL, 1.0 mmol) in dry DCM (degassed bybubbling N2 gas for 5 min). The reaction vessel was rocked at rt for 2 h(released the pressure every 15 min). The solution was drained and theresin washed with DCM (3×5 mL). The deprotection step was repeated,after which the resin was washed with DCM (5×5 mL), DMF (5×5 mL), 1 Mdiethyldithiocarbamic acid sodium salt in DMF (2×5 mL), DMF (5×5 mL),and DCM (2×5 mL).

A solution of PyAOP (105 mg, 0.2 mmol;(7-Azabenzotriazol-1-yloxy)tripyrrolidino-phosphoniumhexafluorophosphate), HOAt (14 mg, 0.1 mmol;1-Hydroxy-7-azabenzotriazole) and DIPEA (90 μL, 0.5 mmol) in DMF (5 mL)was then added to the resin and the mixture shaken for 3 h at rt. Thesolution was drained and the resin washed with DMF (3×5 mL) and DCM (3×5mL). The cyclization step was repeated for 12 h, after which the resinwas washed with DMF (5×5 mL) and DCM (5×5 mL) and dried. The resultantproduct was used directly in the next step.

Step 3: Cleavage from Solid-Support

The resin from Step 2 was transferred to either a 50 mL polypropylenecentrifuge tube or a 10 mL fritted syringe. The peptides were cleavedfrom their solid support using trifluoroaceticacid/triisopropylsilane/DL-dithiothreitol/water (92.5/2.5/2.5 (w/v)/2.5)mixture. For 0.1 mmol scale of resin, ˜10 mL cleavage solution was used.The suspended resin was rocked in cleavage solution for 3 hours at roomtemperature. The filtrate was collected in 50 mL polypropylenecentrifuge tubes and precipitated with chilled diethyl ether (˜50 mL per˜5 mL cleavage filtrate). The precipitated crude peptide was collectedby centrifugation. The white pellet was then subsequently suspended inchilled diethyl ether and collected by centrifugation two additionaltimes. The desired product was purified directly from the crude reactionmixture by C18 reverse phase chromatography.

Table 6 shows the synthetic procedure that was used to synthesize thecompounds disclosed herein.

TABLE 6 Synthetic Compound Procedure 001 E 002 E 003 E1 004 E 005 E 006E 007 E 008 E 009 E 010 E 011 E 012 E 013 F 014 E 015 E 016 E 017 E 018E 019 E 020 E 021 E 022 E 023 E 024 E 025 E 026 E 027 E 028 E 029 E 030E 031 E 032 E 033 E 034 E 035 E 036 E 037 E 038 E 039 E 040 E 041 E 042E 043 E 044 E 045 E 046 E 047 E 048 E 049 A 050 E 051 E 052 E 053 E 054E 055 E 056 E 057 E 058 E 059 E 060 E 061 E 062 E 063 E 064 K 065 E 066E 067 E 068 E 069 E 070 E 071 E 072 E 073 E 074 E 075 E 076 E 077 E 078E 079 E 080 E 081 E 082 E1 083 E 084 E 085 E 086 E 087 E 088 E 089 E 090E 091 E 092 E 093 E 094 E 095 E 096 E 097 E  98 E  99 E 100 E 101 A 102A 103 B 104 B 105 B 106 A 107 A 108 A 109 A 110 A 111 A 112 A 114 A 115A 116 A1 117 A1 118 A 119 A 120 A 121 B

LC/MS analysis: (M)+: Compound 002, expected: 1950.288, found: 1948.912(M+1)¹⁺; Compound 006, expected: 1810.105, found: 1808.817 (M+1)¹⁺;Compound 011, expected: 1578.87, found: 1577.7 (M+1)¹⁺; Compound 016,expected: 1571.77, found: 1570.64 (M+1)¹⁺; Compound 022, expected:1410.8, found: 1409.69 (M+1)¹⁺; Compound 031, expected: 1578.87, found:1577.7 (M+1)¹⁺; Compound 036, expected: 1636.95, found: 1635.75 (M+1)¹⁺;Compound 043, expected: 1643.924, found: 1642.731 (M+1)¹⁺; Compound 047,expected: 1634.96, found: 1633.77 (M+1)¹⁺; Compound 051, expected:1638.98, found: 1637.73 (M+1)¹⁺; Compound 054, expected: 1831.124,found: 1829.838 (M+1)¹⁺; Compound 060, expected: 1618.958, found:1617.772 (M+1)¹⁺; Compound 064, expected: 1507.75, found: 1506.8(M+1)¹⁺; Compound 070, expected: 1603.88 found: 1602.7 (M+1)¹⁺; Compound079, expected: 1657.99 found: 1656.75 (M+1)¹⁺; Compound 090, expected:1892.19 found: 1890.83 (M+1)¹⁺; Compound 092, expected: 1988.23 found:1986.83 (M+1)¹⁺; Compound 097, expected: 1690.96 found: 1689.71 (M+1)¹⁺;Compound 101, expected: 1555.902 found: 1554.74 (M+1)¹⁺; Compound 105,expected: 1283.452 found: 1282.506 (M+1)¹⁺; Compound 108, expected:1616.94 found: 1615.76 (M+1)¹⁺; Compound 114, expected: 1634.957 found:1633.767 (M+1)¹⁺; and Compound 114, expected: 1616.98 found: 1615.76(M+1)¹⁺.

Example 2. Identification of Polypeptides that Bind Specifically toHuman PCSK9 and Inhibit Interaction Between Human PCSK9 and Human LDLR

A set of cyclic polypeptides were identified to inhibit the interactionbetween human PCSK9 and human LDLR. Each polypeptide has an N-terminalamino acid or moiety and a C-terminal amino acid or moiety that islinked by a covalent bond to the other.

A time-resolved fluorescence resonance energy (TR-FRET) assay was usedto measure inhibition of the PCSK9-LDLR protein-protein interaction.Briefly, 20 nM avitag-biotinylated human PCSK9 was incubated with 20 nMhis-tagged human LDLR EGFa domain in the presence of 5 nM LANCE UlightStreptavidin (Perkin Elmer) and 5 nM europium-Anti-6xHis (Perkin Elmer)for 2 hours covered at room temperature in buffer containing 50 mMHEPES, 150 mM NaCl, 5 mM CaCl₂), 0.01% BSA and 0.01% Surfactant P20.Compounds were tested in dose-response and concentrations givinghalf-maximal inhibition calculated using a 4-parameter fit equation.

Table 7 shows IC₅₀ values obtained by the assay for a group of selectcompounds. In Table 7, “A” represents 1 nM<IC₅₀≤100 nM; “B” represents100 nM≤IC₅₀<1000 nM; “C” represents 1000 nM<IC₅₀≤12,100 nM; and “D”represents 21,000 nM<IC₅₀<50,000 nM.

TABLE 7 Compound IC₅₀ 001 C 002 A 003 A 004 C 005 C 006 C 007 C 008 B010 B 013 B 014 A 015 A 016 A 017 B 018 A 019 D 020 D 021 B 022 B 023 A043 B 044 B 046 B 047 B 048 B 049 C 050 B 052 B 055 C 062 B 063 B 071 B072 B 074 B 075 B 076 B 077 B 078 B 079 C 084 B 086 B 091 B 092 B 093 B097 A 098 D 104 C 107 A 108 B 110 A 114 B 115 B 117 B

Example 3. ALEXA FRET

The PCSK9 Alexa FRET Standard assay measured the interaction betweenPCSK9 and an AlexaFluor647 (AF) tagged cyclic peptide, Reagent A(K_(D)=83 nM). A solution containing 1 nM biotinylated PCSK9+2.5 nMLance Streptavidin Europium (Strep-Eu) was made in 50 mM HEPES pH 7.4,0.15 M NaCl, 5 mM CaCl₂), 0.01% BSA, and 0.01% Surfactant P20. Aseparate solution containing 40 nM of the AlexaFluor tagged cyclicpeptide was made in the same buffer system. An Echo was used to transfer0.750ul of compound to an assay plate followed by the addition of 15ulof PCSK9+Stept-Eu and 15ul of AF peptide. The final assay volume was30.750ul containing 0.5 nM PCSK9, 1.25 nM Strep-Eu, and 20 nM AF cyclicpeptide. The reaction was incubated at room temperature for at least twohours prior to fluorescence measurements using an Envision MultilabelReader. IC₅₀ values were determined by fitting data to a sigmoidaldose-response curve using nonlinear regression. K_(i) was thencalculated from the IC₅₀ and the K_(D) of AF cyclic peptide. Counts(B-counts) of the europium-labeled PCSK9 were followed to observe ifcompounds were adversely PCSK9. A fall off of the B-counts likelyindicated a false positive of inhibition. Data from this procedure wasreported as “A=‘numerical value’ (nanomolar)”

Reagent A was prepared in accordance with the following method:

Step A— Synthesis of Intermediate Compound Int-A

The peptide was synthesized on a 0.250 mmol scale on CEM Liberty Blue,Microwave synthesizer using Fmoc/tBu chemistry on PS Rink-Amide MBHAresin, 0.32 mmol The assembly was performed using single-couplings using4 eq of Fmoc protected amino acid 0.2M in DMF, 4 eq of 0.5M HATU in DMF,4 eq of 2M DIPEA (double coupling for Tyr). Fmoc deprotection cycleswere performed using 20% (V/V) piperidine in DMF.The sequence of Fmoc protected amino acids and building blocks usedwere:

-   -   1. N-(((9H-fluoren-9-yl)methoxy)carbonyl)-S-trityl-L-cysteine    -   2.        (S)-1((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-2-methylpyrrolidine-2-carboxylic        acid    -   3. (((9H-fluoren-9-yl)methoxy)carbonyl)-L-tyrosine    -   4. N-(((9H-fluoren-9-yl)methoxy)carbonyl)-N-trityl-L-histidine    -   5.        (S)-2-((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-4-(tert-butoxy)-4-oxobutanoic        acid    -   6.        (S)-2-((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-3-(5-fluoro-1H-indol-3-yl)propanoic        acid    -   7.        (S)-2-((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-3-(5-fluoro-1H-indol-3-yl)propanoic        acid    -   8. (((9H-fluoren-9-yl)methoxy)carbonyl)glycine    -   9.        N²-(((9H-fluoren-9-Amethoxy)carbonyl)-N⁶-(tert-butoxycarbonyl)-L-lysine    -   10. 3-(tritylthio)propanoic acid        At the end of the assembly, the resin was washed with DMF, MeOH,        DCM, Et₂O. The peptide was cleaved from solid support using 50        ml of TFA solution (v/v) (91% TFA, 5% H₂O, 4% TIPS) for        approximately 1.5 hours, at room temperature. The resin was        filtered, washed with TFA and solution concentrated to dryness        and lyophilized. Lyophilization afforded Intermediate Compound        Int. A (399 mg), which was used as crude in the next step. LCMS        analysis was calculated for C61H75F2N1501332: 1328.48, found:        1328.2 (M+1)+

Step B— Synthesis of Intermediate Compound Int-B

Crude Int-A (0.22 mmol) was redissolved in 24 ml of DMF. 6 ml of 1Maqueous solution of sodium bicarbonate was added to raise the pH to 7.Then 0.26 mmol of 1,3-bis(bromomethyl)benzene (0.1M in DMF) was addeddropwise. The reaction was left under stirring at room temperature for20 minutes, quenched with TFA (pH to 3-4) and then concentrated in vacuoto provide crude Int-B, which was purified by RP-HPLC (Waters XBridge,C18, 50x150 mm, 5□m, 130A; 25% to 40% ACN/water+0.1% TFA modifier over20 min). Collected fractions were lyophilized to afford 35 mg ofIntermediate Compound Int-B. LCMS analysis was calculated. forC71H85F2N15013S2: 1458.67; found: 1458.8 (M+1)+.Step C— Synthesis of Compound Reagent A: Intermediate Compound Int-B (15mg) was dissolved in 0.2 ml of dry DMSO. Then 15 mg of ALEXAFLUOR 647NHSEster (A37566, Life technology) dissolved in 1.5 ml of dry DMSO wasadded. 20 uL of dry DIPEA was added. The reaction was left understirring at room temperature for 12 hours under Nitrogen atmosphere inthe dark. Quenched with TFA (pH to 3-4) and purified by RP-HPLC (DrMaish, Reprosil Gold C18, 250x20 mm, 120 A, 10 μm; 20% to 35% of 0.1%TFA in ACN/0.1% TFA in H₂O, over 20 min, then 35% to 40% over 5 min at20 mL/min flow rate). Collected fractions were lyophilized to afford16.1 mg of Compound Reagent A. LCMS analysis was calculated forC105H122F2N17026S6³⁻: 2268.58; 1135.8 (M+2)²±.

Table 8 shows IC₅₀ values obtained by the assay for a group of selectcompounds. In Table 8, “A” represents 1 nM<IC₅₀≤100 nM; “B” represents100 nM<IC₅₀≤1000 nM; “C” represents 1000 nM<IC₅₀≤12,100 nM; and “D”represents 21,000 nM<IC₅₀≤50,000 nM.

TABLE 8 Compound IC₅₀ 002 A 014 A 015 A 016 A 017 A 018 A 019 C 020 C021 A 022 A 023 A 025 A 026 A 029 B 031 A 032 A 033 A 034 A 035 B 036 A038 A 039 B 040 A 041 D 042 A 052 B 071 A 086 B 091 A 097 A 098 B 104 B107 A 110 A

Example 4. ALEXA PLUS FRET

The PCSK9 Alexa FRET Plus assay measured the interaction between PCSK9and an AlexaFluor647 (AF) tagged cyclic peptide, Reagent B (K_(D)=35nM). A solution containing 1 nM biotinylated PCSK9+2.5 nM LanceStreptavidin Europium (Strep-Eu) was made in 50 mM HEPES pH 7.4, 0.15 MNaCl, 5 mM CaCl₂), 0.01% BSA, and 0.01% Surfactant P20. A separatesolution containing 1920 nM of the AlexaFluor tagged cyclic peptide wasmade in the same buffer system. An Echo was used to transfer 0.075ul ofcompound plus 0.675ul of DMSO to each well of an assay plate followed bythe addition of 15ul of PCSK9+Stept-Eu and 15ul of AF peptide. The finalassay volume was 30.750ul containing 0.5 nM PCSK9, 1.25 nM Strep-Eu, and960 nM AF cyclic peptide. The reaction was incubated at room temperaturefor at least two hours prior to fluorescence measurements using anEnvision

Multilabel Reader. IC₅₀ values were determined by fitting data to asigmoidal dose-response curve using nonlinear regression. K, was thencalculated from the IC₅₀ and the K_(D) of AF cyclic peptide. Counts(B-counts) of the europium-labeled PCSK9 were followed to observe ifcompounds were adversely affecting PCSK9. A fall off of the B-countslikely indicated a false positive of inhibition. Data from thisprocedure was reported as “P=‘numerical value’ (nanomolar)”

Reagent B was prepared by the following procedure.

Step A— Synthesis of Intermediate Compound Int-A The peptide wassynthesized on a 0.250 mmol scale on CEM Liberty Blue, Microwavesynthesizer using Fmoc/tBu chemistry on PS Rink-Amide MBHA resin, 0.32mmol V. The assembly was performed using single-couplings using 4 eq ofFmoc protected amino acid 0.2M in DMF, 4 eq of 1M Oxyme in DMF, 4 eq of0.5M N,N-diisopropylcarbodiimide (DIC) (double coupling for Y01). Fmocdeprotection cycles were performed using 20% (V/V) piperidine in DMF.

The sequence of Fmoc protected amino acids and building blocks usedwere:

1. N-(((9H-fluoren-9-yl)methoxy)carbonyl)-S-trityl-L-cysteine

2.(S)-1((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-2-methylpyrrolidine-2-carboxylicacid

3.(S)-2-((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-3-(4-methoxyphenyl)propanoicacid

4. N-(((9H-fluoren-9-yl)methoxy)carbonyl)-N-trityl-L-histidine

5.(S)-2-((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-4-(tert-butoxy)-4-oxobutanoicacid

6.(S)-2-((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-3-(5-fluoro-1H-indol-3-yl)propanoicacid

7. (S)-2-((((9H-fluoren-9-yl)methoxy)carbonyl)amino)-3-(5-fluoro-1H-indol-3-yl)propanoic acid

8. (((9H-fluoren-9-yl)methoxy)carbonyl)-D-alanine

9.N²-(((9H-fluoren-9-yl)methoxy)carbonyl)-N⁶-(tert-butoxycarbonyl)-L-lysine

10. 3-(tritylthio)propanoic acid

At the end of the assembly, the resin was washed with DMF, MeOH, DCM,Et₂O. The peptide was cleaved from solid support using 50 ml of TFAsolution (v/v) (91% TFA, 5% H₂O, 4% TIPS) for approximately 1.5 hours,at room temperature. The resin was filtered, washed with TFA andsolution concentrated to dryness and lyophilized. Lyophilizationafforded Intermediate Compound Int. A (300 mg), which was used as crudein the next step. LCMS analysis was calculated for C63H79F2N15013S2:1356.53, found: 1356.9 (M+1)+.

Step B— Synthesis of Intermediate Compound Int-B

Crude Int-A (0.22 mmol) was redissolved in 24 ml of DMF. 6 ml of 1Maqueous solution of sodium bicarbonate was added to raise the pH to 7.Then 0.26 mmol of 1,3-bis(bromomethyl)benzene (0.1M in DMF) was addeddropwise. The reaction was left under stirring at room temperature for20 minutes, quenched with TFA (pH to 3-4) and then concentrated in vacuoto provide crude Int-B, which was purified by RP-HPLC (Waters XBridge,C18, 50x150 mm, 52m, 130A; 25% to 40% ACN/water+0.1% TFA modifier over20 min). Collected fractions were lyophilized to afford 35 mg ofIntermediate Compound Int-B. LCMS analysis was calculated. forC71H85F2N15013S2: 1458.67; found: 1458.8 (M+1)+.

Step C— Synthesis of Compound Reagent B

Intermediate Compound Int-6 (15 mg) was dissolved in 0.2 ml of dry DMSO.Then 15 mg of ALEXAFLUOR 647NHS Ester (A37566, Life technology)dissolved in 1.5 ml of dry DMSO was added. 20 uL of dry DI PEA wasadded. The reaction was left under stirring at room temperature for 12hours under Nitrogen atmosphere in the dark. Quenched with TFA (pH to3-4) and purified by RP-HPLC (Dr Maish, Reprosil Gold C18, 250x20 mm,120 A, 10 μm; 20% to 35% of 0.1% TFA in ACN/0.1% TFA in H₂O, over 20min, then 35% to 40% over 5 min at 20 mL/min flow rate). Collectedfractions were lyophilized to afford 16.1 mg of Compound Reagent B. LCMSanalysis for C107H126F2N17026S6³⁻:2296.64; found: 1150.6 (M+2)²⁺.Activity data obtained by one or both of the above-described procedureswas reported for selected example compounds of the invention in thefollowing format:

Example No.: A (standard TR Fret)=‘Numerical Value’; P (Alexa Fret PlusStandard TR Fret)=‘numerical value’/, note that all values reported arenanomolar

Table 9 shows 1050 values obtained by the assay for a group of selectcompounds. In Table 9, “A” represents 1 nM<IC₅₀<100 nM; “B” represents100 nM<IC₅₀<500 nM; and “C” represents 500 nM<IC₅₀ <5000 nM.

TABLE 9 Compound IC₅₀ 014 A 015 A 016 A 031 A 032 A 034 A 035 B 036 A039 A 040 A 041 C 042 A * * * * *

The contents of the articles, patents, and patent applications, and allother documents and electronically available information mentioned orcited herein, are hereby incorporated by reference in their entirety tothe same extent as if each individual publication was specifically andindividually indicated to be incorporated by reference. Applicantsreserve the right to physically incorporate into this application anyand all materials and information from any such articles, patents,patent applications, or other physical and electronic documents.

The methods illustratively described herein may suitably be practiced inthe absence of any element or elements, limitation or limitations, notspecifically disclosed herein. Thus, for example, the terms“comprising,” “including,” containing,” etc. shall be read expansivelyand without limitation. Additionally, the terms and expressions employedherein have been used as terms of description and not of limitation, andthere is no intention in the use of such terms and expressions ofexcluding any equivalents of the features shown and described orportions thereof. It is recognized that various modifications arepossible within the scope of the invention claimed. Thus, it should beunderstood that although the present invention has been specificallydisclosed by preferred embodiments and optional features, modificationand variation of the invention embodied therein herein disclosed may beresorted to by those skilled in the art, and that such modifications andvariations are considered to be within the scope of this invention.

The invention has been described broadly and generically herein. Each ofthe narrower species and subgeneric groupings falling within the genericdisclosure also form part of the methods. This includes the genericdescription of the methods with a proviso or negative limitationremoving any subject matter from the genus, regardless of whether or notthe excised material is specifically recited herein.

1-11. (canceled)
 12. A bicyclic polypeptide compound selected from thegroup consisting of:

or a pharmaceutically acceptable salt thereof.
 13. The compound of claim12, having the following structure:

or a pharmaceutically acceptable salt thereof.
 14. A pharmaceuticalcomposition comprising a cyclic the bicyclic polypeptide compound ofclaim 12 and a pharmaceutically acceptable carrier.
 15. A method ofreducing low density lipoprotein (LDL) cholesterol level in a subject inneed thereof comprising administering to the subject a therapeuticallyeffective amount of the cyclic bicyclic polypeptide compound of claim12.
 16. The method of claim 15, wherein the subject hashypercholesterolemia.
 17. The method of claim 16, wherein the bicyclicpolypeptide compound inhibits the interaction between human PCSK9 andepidermal growth factor-like repeat A (EGF-A) domain of human lowdensity lipoprotein (LDLR).
 18. A method of treatinghypercholesterolemia in a subject in need thereof comprisingadministering to the subject a therapeutically effective amount of thebicyclic polypeptide compound of claim
 12. 19. The method of claim 18,wherein the subject further suffers from a disease that showscomorbidity with hypercholesterolemia.
 20. The method of claim 19,wherein the disease that shows comorbidity with hypercholesterolemia isselected from the group consisting of nephrotic syndrome, kidneyfailure, coronary artery disease, atherosclerosis, stroke, peripheralvascular disease, diabetes, and high blood pressure.
 21. A method ofinhibiting PCSK9 activity in a subject in need thereof comprisingadministering to the subject a therapeutically effective amount of thebicyclic polypeptide compound of claim
 12. 22. A method of inhibitingPCSK9 activity in a cell comprising contacting the cell with thebicyclic polypeptide compound of claim
 12. 23. A method of inhibitingthe interaction between PCSK9 and the EGF-A domain of LDLR in a subjectin need thereof comprising administering to the subject atherapeutically effective amount of the bicyclic polypeptide compound ofclaim
 12. 24. The method of claim 15, wherein the administration isselected from the group consisting of oral, intravenous, intramuscular,intraperitoneal, subcutaneous, transdermal, and intravitreal.
 25. Themethod of claim 18, wherein the administration is selected from thegroup consisting of oral, intravenous, intramuscular, intraperitoneal,subcutaneous, transdermal, and intravitreal.